Journal of Hematology - Supplements - Haematologica

31
reported on the initial experience concerning
633 searches activated for Italian patients and
75 BMTs from UDs performed in GITMO institutions.
5 In this report, we present the results of
the initial 696 UD BMTs performed in Italy
between September 1989 and December 1999.
Design and Methods
IBMDR
The IBMDR was established as a collaborative
effort among the Regional Tissue Typing
Laboratories. Its principles and policies are similar
to those of other international Registries. 7-11
IBMDR includes 17 local Registries and 100
donor centres for the HLA class I and II serological
typing of volunteer donors.
Donor recruitment
In December 1992 the number of donors was
25,000. Over the following years more than
20,000 new donors per year have been added to
the registry. Currently, the IBMDR file contains
data concerning approximately 260,000 volunteers.
All of them are HLA-A,B serologically
typed, while HLA-DR serological typing has also
been performed on 86,000 (33%) of these registered
donors. The DRB1 typing by PCR technique
of 11,000 donors is also available. Once
a month the IBMDR electronically sends its
donor HLA phenotype file to the Bone Marrow
Donors World Wide (BMDWW) directory, which
includes more than 6,000,000 donors in its May
2000 edition. 12
All the Italian transplant centers (TC) involved
in this programme are accredited through the
GITMO to the IBMDR, to European Registries
and to the National Marrow Program of the United
States of America (NMDP), according to the World
Marrow Donors Association standards.
Matching criteria
Before December 1991 most TC based their
matching criteria on HLA-A,B,DR identity using
serologic testing. After January 1992 class II antigens
matching was confirmed by DNA techniques
as previously described. 5
Engraftment
Neutrophil engraftment was defined as the
first of 3 consecutive days with an absolute neutrophil
count (ANC) >0.5×10 9 /L, whereas
platelet engraftment was defined as the first of
3 consecutive days with an untransfused platelet
count >50×10 9 /L.
Data collection and statistical analysis
Essential data regarding all donor-recipient
pairs, and information concerning the harvesting
procedure were obtained by the IBMDR data
centre. Information on the BMT procedure and
on the recipients follow-up were collected every
year by the GITMO Registry. Univariate analysis
was performed for relapse, for disease-free survival
(DFS), and for transplant-related mortality
(TRM). TRM was defined as mortality due to
any cause other than disease progression in
patients with haematological malignancies. Life
tables (Kaplan-Meier estimates) were calculated
at 3 years to measure the proportion of patients
alive or, for malignancies, alive and disease-free.
Data were updated as of December 31 st , 1999.
Results
The search
Between September 1 st 1988 and December
31 st 1999 the search for an UD was started for
2,620 patients. Half of them were activated during
the last three years. During the last 12
months, a formal search was started each month
for approximately 40 new Italian patients.
Probability of finding a matched donor
At least one HLA-A,B,DRB1 matched donor
was found for 54% of the patients. At least one
1 antigen mismatched donor was found for 66%
of the patients. At least one HLA-A, B, CW,
DRB, DQA, DQB matched donor was found for
28% of the patients.
As of December 1999, 696 Italian patients
had undergone UD BMT in one of the 31 TC
participating in this program. Three hundred sixty-seven
of them were over 18 years of age, while,
329 were 18 years old or less. Half of them were
transplanted during the last 25 months. In 1999
each month approximately 15 new Italian
patients underwent UD BMT. Details on the
activity of the 31 TC are reported in the Appendix.
The characteristics of donors and recipients
listed according to the type of disease that led to
transplant are reported in Table 1.
Donor Registries
The first UD BMT performed in Italy was made
possible in March 1989 by a donor listed with
the Anthony Nolan Research Foundation. The
first UD marrow provided by the IBMDR was
grafted in March 1991. By December 1999, 347
donors had been provided by the IBMDR and
349 by other Registries, as shown in Table 2. As
of 1997 the IBMDR has become the main
source of donors for Italian patients.
Donor Recipient matching
Six hundred out of 696 pairs were HLA-
A,B,DRB1 matched, while 80 pairs were mismatched
for at least one antigen. Data concerning
the remaining 16 pairs are missing.
Details on matching by recipient age are reported
in Table 3.
haematologica vol. 85(supplement to n. 11):November 2000